Phase I: Protection and Early Motion (0–2 Weeks)

Immobilisation:

• Sling worn at all times

• Remove sling only for hygiene and supervised therapy

Precautions:

• No active wrist or finger extension or forearm supination

• Avoid resisted gripping, lifting, or wrist motions

• No forceful forearm rotation

• Keep wound clean and dry

Therapy:

• Begin hand, wrist, and shoulder active range of motion (excluding wrist extension/supination)

• Elbow passive flexion/extension in pain-free range

• Hand, finger, and grip activation without resistance

• Rest, ice, compress and elevate (RICE) for pain and inflammation.

Criteria to Progress:

• Wound healing progressing without complications

• Pain well controlled

• Tolerates light motion within limits

Phase II: Controlled Mobilisation and Early Strengthening (2–6 Weeks)

Immobilisation:

• Discontinue sling gradually from week 2

Precautions:

• Avoid resisted wrist and finger extension until week 6

• Avoid heavy gripping, lifting, or repetitive twisting motions

Therapy:

• Begin active range of motion of the wrist, fingers, and elbow

• Gentle passive and active-assisted wrist extension and forearm pronation/supination

• Begin isometric wrist flexion, pronation, and ulnar deviation

• Continue shoulder and scapular muscle activation

Criteria to Progress:

• Pain-free ROM of the wrist, elbow, and forearm

• Tolerance of light resisted motions without irritation

• No localised inflammation or swelling

Phase III: Strengthening and Neuromuscular Training (6–12 Weeks)

Precautions:

• Avoid eccentric overload of wrist extensors

Therapy:

• Progress to resisted wrist and forearm exercises, including wrist extension

• Begin eccentric wrist extensor strengthening (e.g., Theraband flexbar)

• Neuromuscular training for grip control and endurance

• Initiate functional upper limb patterns and proprioception drills

Criteria to Progress:

• Strength approaching 70–80% of contralateral side

• No pain with resisted wrist extension

• Full, pain-free range of motion

Phase IV: Return to Full Activity (3–6 Months)

Precautions:

• Avoid high-repetition gripping or forceful torque activities until cleared

Therapy:

• Return to work-specific or sport-specific training

• Progress strengthening and endurance activities

• Gradual reintroduction of racquet sports, weight training, and occupational tasks

• Plyometric and agility training as appropriate

Criteria to Discharge:

• Pain-free functional activity

• Symmetrical grip strength and endurance

• Return to previous work or sport level with surgeon clearance

General Recommendations

Work:

• Office/desk work may resume after 2–4 weeks if pain is well controlled

• Manual labour should be deferred until 3–6 months depending on job demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Lower-limb activities may resume as comfort allows.

• Light upper limb activities may resume from approximately 2–4 weeks.

• Progressive return to gym and functional activities from 6–8 weeks.

• Resisted gripping and lifting from approximately 8–10 weeks.

• Racquet sports and higher-demand activities from 3–4 months or longer with full recovery and surgeon clearance.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.